Wednesday, June 27, 2007

For students -- Too menial for you?

Now that I am in college, I have been looking to obtain some medical related experience through volunteer work. I have tried the volunteer programs at some Boston hospitals, but I did not find them to be meaningful. They would generally consist of pushing patients around. I feel this is much less helpful than serving people in a soup kitchen or homeless shelter. Moreover, the volunteer sheet would often be filled months in advance, so it was as if me being there did not help anybody at all because many others were clamoring for the precious volunteer hours. The supply vastly exceeded demand. Overall, the activity seemed to be just designed to be put on a piece of paper or medical school application instead of being a program that really helped people.Do you have any recommendations for volunteer activities which provide medical experience and help people in a meaningful way in the Boston area, and which are accessible by public transportation for us poor undergraduates?I want to answer this is in a kind and gentle way, but here's the best I can do: Tristan, your definition of meaningful is a bit elitist. But let's just attribute it to a lack of understanding. Let me try to explain with the very example you cited.

Let's talk about "pushing people around." The people who push people around in a hospital are not only performing an important job, i.e., delivering bedridden or wheelchair-dependent patients to test, appointments, or other activities -- but the way they do the job is extremely important to the patient's experience. Their approach and demeanor can make the difference between a patient's feeling relaxed, comfortable, and welcome in a hospital and feeling like a slab of meat being delivered to the corner deli.

In our hospital, a gentleman named Chris who works as a transporter not only is friendly, polite, and helpful to his clients, but he actually sings to them while they are in transit. (He has a lovely, soft voice.) So, imagine you are tired, anxious, and upset and Chris is lovingly transporting you for an X-ray or other test. As you lie there in bed, you hear beautiful music wafting over you. You can't help but feel welcomed and comfortable and less anxious.

Tristan, there is human drama every moment in a hospital, thousands of times per day. Our job is to alleviate human suffering caused by disease. There is not one post in a hospital that is not meaningful in pursuit of that goal. You just have to look a bit deeper and find the meaning.

Also, there is meaning in the relationships you create with employees and other volunteers. Learn what they do and how they do it; learn about their backgrounds and their families; and learn how they express the values of the institution in their work every day. Even if the actual work you are doing is a bit tedious, the relationships you establish will teach you plenty.

As to your last question, every hospital in Boston is on a transit line, so access is not a problem. And there is no surplus of volunteers, regardless of what a signup sheet on a college bulletin board might show. Call up the volunteer services office in any hospital, talk to them, and I guarantee you will find something to do.

By the way, my first volunteer job was pushing patients in beds and wheelchairs in a hospital in New York City when I was in high school!

24 comments:

Anonymous
said...

Honestly, in my work as a hospital-based doc I found the transporters and orderlies to be among the most friendly and customer-sensitive in the place!As for meaningful and getting medical experience, the sad fact is that there is little an untrained person can do in a hospital except clerical work or this type of patient contact. But as Paul mentions, it's often those little things that mean the most to patients, to whom an encounter with nurses and docs often means pain or anxiety. Make their day!!

ya...nurses and docs just sticks people with needles and/or tubes. (no offense, i guess it just needs to be done) Okay, they do much more than that. :)

Random tip: be sure to turn the patient around when you wheeling them into the elevator, so they face the door.

I particularly like this quote..."Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around." - Leo Buscaglia

If the type of volunteer experiences that you are seeking are not available in the hospital, perhaps you should expand your definition of health. There are excellent community health agencies, which like hospitals, are in need of volunteers.

As an undergrad, I volunteered with an HIV/AIDS Network and an Immigrant Health Group. Both experiences expanded my notion of health and provided me with meaningful experiences.

Paul, this may be the best thing you've ever written, if the criterion is a superb insight into what appears to be a mundane subject. You hit the nail SQUARE on the head.

I'll never forget the first time I got transported. The guy who did it didn't sing to me, but he was clearly attentive to my needs, aware of every bump we were going to go over (and warned me and slowed down as we hit it), letting me know how far we were from the destination, etc.

In general, he was Being Of Service to me - a gentle voice of someone I couldn't see (he was behind me, pushing my wheelchair). And even though I was particularly anxious at that moment, I had the experience of being well cared for (and cared about). How great is that?

Tristan, there's gold in this conversation. Can you find a way, in every moment, to be of service? If you can, then I'd bet dollars to doughnuts that you'll be a better physician years from now.

I vividly remmber one particular incident which happened several years ago in India while i was in my early surgical training.

I was working as a lowly orthopedic intern to a top orthopedic surgeon in India. On that particular day, there was one patient waiting in the floor to be transported to the OR. I wrote the orders for pre-op medications and transfer. I got couple of pagers from OR to send the patient ASAP.There was no sign of orderly coming to transport the patient. I was waiting impatiently for some kind of staff to take the patient to OR.Minutes were rolling fast...more pagers. In India, doctors dont perform menial jobs like pushing the wheel chair or stretchers.

Afer some time, my boss (the top surgeon) came from the OR in scrubsand asked what's goin'on? I explained to him....orderly not here..blah..blah. He looked into my eyes for a moment and turned back. He started rolling the stretcher with the patient to the OR fast. I was stunned and started running behind him following the stretcher.He said to me clearly....first lesson in surgical training is to learn how to push the stretcher...and the rest follows.I think i learnt my first lesson that day.

When I ended up in BIDMC, I was discombobulated and in serious pain, but I still clearly remember the transporter who kindly introduced himself, asked my name, and asked how I was doing. And the transporter who got me an extra jonnie without my asking because he thought I looked cold. I doubt either one of them had any formal medical training, but they certainly contributed to making me feel better.

Excellent post! I volunteered at a small community hospital as a college student. I poured water at patients' bedsides, transported patients to tests or sometimes just provided an opportunity for a lonely person to engage in conversation. I didn't recognize it at the time, but I was further developing my communication skills. My graduate school application mentioned that I had volunteered at a hospital and that I learned to communicate with the sick and the elderly. My experience as a volunteer was truly a blessing and an opportunity to make a difference.

Does anybody remember the scene in Escape from Alcatraz where the prisoners volunteer to paint? They learn an incredible amount of information needed to plan their escape because they are simply there in the office, even though nobody notices.

Working simple jobs in a hospital is much the same thing. You are everywhere, and not focussed on anything in particular. What you take in through your eyes and ears when your brain isn't that busy can be immensely informative. You are, in a strong sense, embedded in the environment even if you are not a prime actor.

Push the bed, treat the occupant with great humanity, and put your antennae up and you can learn a lot about how the whole mess fits together and where you might fit into it.

Excellent post, Paul! As a former premed (and now a medical student), I have definitely been in Tristan's shoes and felt the same way. However, you can't expect to enter the hospital and do neurosurgery on the first day! Medical care involves much more than the procedures and the diagnostic and treatment decision processes. Furthermore, it's easy to confuse "glamorous" with "meaningful." For example, many people don't understand what anethesiologists do; they think that anesthesiologists just stand around and look at the monitors while surgeons do all the work in the OR. However, the success of the surgery depends on the success of the balancing act performed by anesthesiologists to bring patients into an appropriate subconscious state, bring them back, and maintain their status when things go wrong.

At the same time, I suspect that everyone is being a little bit too harsh on Tristan. It's likely that he (and most volunteers) are interested in exploring what physicians do. Hospitals aren't just populated by physicians, though, and possibly are not the best places for premedical students to learn about medicine as a career. However, college and high school students can learn a lot about how hospitals function, what patients experience, and who works in hospitals. It seems that students should not be guided toward these experiences with the mindset of learning about physicians, but rather, these experiences are best for showing them what it is like to be a patient in today's health care system (and also who are the people who interact with patients for the other 23 hours and 45 minutes when they are not speaking with physicians). Students like Tristan should be encouraged to look at these volunteer experiences differently but also be guided toward programs that involve more shadowing experiences (if these exist), rather than being "rewarded" by a single shadowing experience at the end of 60 or so volunteer hours.

I volunteered at a hospital at the age of 14, as a candy striper. My duties were filling water pitchers, bringing food trays, delivering flowers and safely delivering consumers to their destinations. I was saddened by the number of old folks that had very few visitors, even at that young age. Being just a kid, I didn't think that I could add very much to their stay but I soon realized that I represented those grandchildren that didn't have time to visit their grandparents.

I became good friends with a gentle woman who seemed quite lonely. I would stay after hours and talk with her. We wrote to each other throughout high school and college and often mailed each other small gifts. She attended my wedding and I attended her funeral. She will always be one of those precious souls that remain in my heart. She taught me about compassion.

PS...I hope those disrespectful hospital gowns now snap in the front! Decades later, I still have quite the memory of wrinkled backsides that a 14 year old should not see.

Leaving aside the meaning of transportation work in a hospital, I'd like to dispute the idea that a hospital will always find work for a volunteer.

They will -- after a background check, three references, drug testing, TB testing, proof of academic enrollment, a personal interview, and the three to six months required by the volunteer office to process this information. Then they give you a choice of six shift times in the program, all of which are smack in the middle of the working or class day, because the regular volunteers were allowed to sign up first.

At the same time, many medical schools are firmly convinced hospital time is the best way to spend your summers. Which is wonderful, if you're warned in advance that it takes months to get on board and that you'll have to find summer employment on graveyard shifts to cover those volunteer hours.

As a medical student who volunteered in DC, Boston, and NYC, I found the Boston hospitals to be the least helpful, most complicated to enroll, and least rewarding volunteer commitments. The DC and NYC hospitals at least offered a very clear incentive system that wouldn't take a whole year to fulfill. And didn't seem to require as much processing.

Putting aside the paperwork, which I do understand some of the time (if not the six months of bureaucracy), I was disappointed by the unreasonable goals before incentives were offered. 600 hours before one day of shadowing? Really? 1000 before watching a surgery? How can I do that in a summer while holding down a job to pay for my living expenses? Plenty of hospitals ask for a more realistic contribution before offering a brief glimpse what premeds hope they'll see, and it's worth trying to find them.

To any premed student looking for volunteering: try contacting a physician to shadow and see what comes up. ER scribe programs are also a great way to see more of the hospital and sometimes they even pay you for the service. Hospices and free health clinics are also great ways to get a different kind of health experience. Hospitals aren't bad, and plenty of other commenters have pointed out why, but some make the whole process much too complicated.

If you are looking for a volunteer position in which you will get to shadow doctors treating patients and get experience in ORs and other clinical settings, in the hope of boosting your resume for medical school, you are in a very different category from someone who just wants to help out. For sure, we would put you through all those checks, tests, and references. The kind of service you are seeking takes a major commitment from the medical staff, in terms of supervision. You are, in essence, competing for their time with medical students and residents, time which they allocate for teaching. So, we would want to make sure you are a serious pre-med candidate.

Your desire to "volunteer" is fraught with "what's in it for me?" which I find very disheartening because I'm afraid you will not be happy as a physician. There are many, many things we do in medicine with absolutely no expectation of return, and we do them because medicine truly is a calling, not a "job." Actually, there is a "return," and it is in the good feeling of having helped another human being, which you seem to have missed during your volunteer time, which you appear to view as "dues to be paid" in order to do what you were really after, i.e. shadowing a doc. Sometime before you graduate from medical school, look up the meaning of tzedakah, and meditate on it for awhile. You will be a better physician and you will be happier in your life. (You think you had to jump through hoops to be a volunteer?!?!?)

I'm consistently amazed by the shocking lack of work ethic among volunteers at my hospital. If they can't run the show, it's just not worth their time. They're too good to help older patients to the bathroom, apparently. No, they just want in on the traumas. Sorry, this isn't Grey's Anatomy or ER -- you're a volunteer, at the very bottom of the totem pole, and you'll do scut. That's how it works. Oh, and no you cannot tell me what I need to be doing on YOUR FIRST DAY. I don't give a damn that you're "going to be a doctor in a few years" -- right now you are a volunteer, and not even an experienced one. Whatever happened to the idea of paying your dues? Ugh. My experience with pre-med volunteers has not been pleasant.

What a great topic, and an honest question too. As someone who is also looking for experience in a healthcare setting, I'd like to thank Paul, Tristan, and the folks that have responded.

Helping people is it's own reward. Getting to know the patient's side of the experience (also Illness Vs Disease) is also an important lesson. No job is too small or lacks meaning.

If I value all the above and wish to gain more knowledge about the inner workings of a hospital while volunteering, I think swirlygrrl's idea of keeping one's head up and taking it all in maybe a key. Erik's bit about looking beyond hospitals is a point well taken. However, I don't really know.

I would think that being a transporter would give one plenty of opportunities to learn about the inner working of a hospital but do folks have any interesting suggestions about what to look for?

(I learned more about the electronics industry as a summer temp in their facilities department than taking an MBA class -or two!)

Being transported and seeing the ceiling flowing by makes me feel much more like a sick person, so being able to chat with the transporter is invaluable. I also get interesting info (one guy said he had been a patient recently and got tons of insight). The transporters also remember you (say you need an x-ray every day as I did once time). It's nice.

I've been thinking about this, and about my own pre-medical volunteer experiences, and I think there's a couple extra points to add (though you have all created an amazing dialogue).

When I first began volunteering at a hospital here, I was disappointed because I couldn't do more. It wasn't that I felt useless, but that I really wanted to sweep in and feel like I was making a tangible, immediate difference. Because of liability issues, "student" volunteers weren't allowed to transport patients or anything so instantly understandable as "service" aside from restocking supplies (which is, of course, very useful).

The largest part of my disappointment was a strong desire to serve - isn't that what is driving all medical students? But the more I thought about it, the more I realized that I was, in fact, serving, just not in the most tangible of ways. I was the one person in the hospital who could sit with a lonely patient, watch movies with a child on the burn unit, find a current magazine issue for a family member waiting through a surgery. I was there to be the one person who actually had time for the patients.

Was it a "medical" experience? Maybe not. I didn't do what most of us think of as "medical things," or watch procedures, etc. Was it a health care experience? You bet, and perhaps one of the best sorts. Was it something that required a mental adjustment to understand? Yes, and I think that's important too. Serving in a soup kitchen is an immediate reward-for-service experience (and is a valuable service, of course). Sitting with a tired and lonely patient is much less tangible, but feeding the soul can be just as important as feeding the mouth, and just as critical to health care.

That said, Tristan, you also expressed some very valid concerns in terms of volunteer hours being full and that hospital volunteering is often treated as a check-mark on the list of "things that get you into medical school." I have experienced both problems, and they're frustrating. I would suggest that you keep up the hospital volunteering as best you can in terms of schedule, and disregard the attitudes of admissions personnel who push for hospital hours above all else. Don't put up with anyone "ranking" different forms of volunteering, because that's a discredit to all service.

I would also suggest that if you want more volunteer time, that you begin looking at other ways/places to volunteer (and I realize that this is sort of waht you were asking Paul about), but in the knowledge that you're doing it because you want to do more service, not because you think it will be more meaningful. For example, I spent two years volunteering in an in-patient hospice facility. It's the same kind of idea - you are the person who has all the time in the world to care, and thus you are doing a great, if less immediately apparent, service. Are their clinics for the medically-underserved in the Boston area that you can work in? Here, I think they always need people to greet, read to small children, work through the massive paperwork, etc....

When you get to med school, Tristan, you will, indeed, meet many people who used hospital volunteer time as a checkpoint on their admissions list, and learned nothing from the experience. If you stop and think about how much you're really doing, you'll have gleaned one of the first important lessons of actual health care, and it will make medical school more meaningful. You will perform patient interviews differently, walk down hospital hallways differently, and generally see the care process differently (dare I say, more holistically?), because you will understand the intangibile nature of caring.

Tristan, As someone who was looking for a similar opportunity as you, I can relate to your situation. I wanted to find a position that allowed both patient contact as well as a sense of importance. And as a current volunteer at BIDMC, I have found my experiences in the PACU to be just that and more. Right away the nursing and medical staffs made me feel like a valuable component to their team. Do I wheel patients around? Yes, along with several other tasks, but volunteering positions are jobs with minimal training and for individuals who are looking to lend a hand. It also helps that I really enjoy that interaction with the patients and their families when I am walking them to their car. I also know (because I have been told by some patients) that they are very appreciative for everything we do for them no matter how small it may seem to us.

But there are also so many more intangible aspects to volunteering that can be missed. While in the PACU I have been able to observe some wonderful nurses and see how they work with the patients. I have been able to experience what it is like to work in a medical atmosphere and as a member of a medical team. Just to see how a hospital functions is amazing. All of these observations will help you down the road when you will be more qualified in the medical field. You will already have the knowledge of how to work with medical staff, and a greater understanding of what the patient’s experience is like. BIDMC also has opportunities for volunteers to observe surgeries, which is an exciting option to have.

Volunteering is all about what you want to make of it. If you consider pushing patients around to be a menial task, then you will not receive much from your experience. But if you take it upon yourself to interact with patients and staff, observe everything that is going on around you, and take the extra steps to become more involved, then you will find any volunteering experience to be invaluable.

As a short note to John, one of the things that I enjoy is observing the nurses when an issue arises with a patient. They work so well as a unit and will discuss what the best approach is. It is very interesting to watch them use their knowledge and problem solving skills to put together all the pieces and come to a solution for the issue at hand.

I find the repetitive referral to "pushing patients around" as a menial task very amusing---I am a senior physician at BIDMC (anesthesiologist) and somehow I do not find it beneath me to push a stretcher. . .

The rehab services department (physical therapy and occupational therapy) most always could use volunteers and I'm not sure exactly how it works but I know we may be able to utilize volunteers on the floor as "ambulators" helping patients who just want to get out of their room and around the floor safely while they do so (given IV poles, the need for supervision and the tight room spaces). Call the rehab dept...it doesn't hurt to ask!!! Bonus if you're interested in becoming a PT/OT!!!

I volunteer at BIDNeedham and have done so for one year. I started as a "break" from my Hospice volunteer work which had taken a toll. I needed to be in a new setting for a while, with different challenges, tasks and with more people to work with. I have found being an escort to be highly rewarding. The moments of comfort and even levity I can bring to patients and their families are precious to me.

I can even lighten the atmosphere with the doctors and nurses who work hard daily. On my two days a week, I walk in with the attitude of "who can I make laugh today, who can I bring a smile to today?"

I also come into the hospital eager to learn from all around me. I watch the nurses, doctors, technicians and other staff to learn from their professionalism, to see what gifts they have to give that I might benefit from. Everyone approaches life differently, however, there are lessons in abundance if one only looks around.

After several months away from Hospice, I was renewed by my work at Needham. I have now returned to my Hospice work---along with my two days a week at Needham. I cannot imagine giving up my escorting.

And Tristan, I have made friends and met people I would never have known had I not been in the escort program. It is one of the bright spots of my week!